A comparative study of the effect of prophylactic intravenous antibiotics and triclosan-coated sutures in the prevention of surgical site infection in pediatric groin surgeries

A comparative study of the effect of prophylactic intravenous antibiotics and triclosan-coated sutures in the prevention of surgical site infection in pediatric groin surgeries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A comparative study of the effect of prophylactic intravenous antibiotics and triclosan-coated sutures in the prevention of surgical site infection in pediatric groin surgeries Emmanuel Nwangwu, Elochukwu Nwankwo, Uchechukwu Ezomike, Christopher Amah, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8902559/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 16 You are reading this latest preprint version Abstract Background Surgical site infections (SSIs) continue to occur following clean pediatric groin surgeries, despite being considered low-risk procedures. Various preventive measures have been explored to reduce this morbidity. Objectives This study aimed to compare the effectiveness of a single-dose prophylactic intravenous antibiotic regimen with triclosan-coated suture material in preventing SSI in pediatric groin surgeries. Materials and Methods A prospective comparative study was conducted on pediatric patients who underwent repair of inguinal hernias or hydroceles at the University of Nigeria Teaching Hospital (UNTH), Enugu. Participants were assigned to two groups: Group A received wound closure with triclosan-coated polyglactin-910 (Vicryl-Plus), and Group B received a single preoperative intravenous dose of ampicillin/cloxacillin 30 minutes before incision. All patients were followed up for 30 days. Data were analyzed using IBM SPSS version 21.0. Categorical variables were summarized using frequencies and percentages, while continuous variables were analyzed using means and standard deviations. Chi-square tests assessed associations between categorical variables, and T-tests compared means. Statistical significance was set at p < 0.05. Results A total of 96 groin surgeries were performed on 86 patients, including 10 bilateral hernia repairs. There were 63 males (73.3%) and 23 females (26.7%). Forty-one (47.7%) had unilateral inguinal hernias, 10 (11.8%) bilateral hernias, and 35 (40.7%) hydroceles. Only one SSI (1.0%) occurred, observed in the antibiotic group (χ²=1.011, p = 0.315). Seroma occurred in 2.1% (1/48) of the Vicryl-Plus group and 4.2% (2/48) of the antibiotic group (χ²=0.344, p = 0.557). The SSI was superficial and resolved with an alternate-day dressing. Conclusion T riclosan-coated sutures and single-dose antibiotics showed similarly low SSI rates in pediatric groin surgeries. The only SSI occurred in the antibiotic group. Triclosan-coated sutures may reduce antibiotic use without compromising outcomes. Pediatric groin surgeries antimicrobial (Triclosan) coated suture prophylactic antibiotics surgical site infections Figures Figure 1 Introduction Surgical site infections constitute up to 20% of all healthcare-associated infections, and at least 5% of patients undergoing a surgical procedure develop a surgical site infection [ 1 ]. It is known that this incidence varies depending on the surgical procedure, the surveillance criteria used, and the quality of data collection [ 2 ]. Antibiotic prophylaxis is of significant benefit where the surgical site infection rate is greater than 5% [ 3 , 4 ] At the University of Nigeria Teaching Hospital, single-dose prophylactic antibiotics are used routinely for pediatric groin surgeries. The prevailing environment and risk of surgical site infections fuel this practice. Despite the prevalence of surgical site infection in our environment, there is a paucity of research on the prevention of surgical site infection in children, especially in the use of antimicrobial-coated sutures for surgical wound closure. This intervention has been reported to be effective in preventing surgical site infection. Hence, this study compares the effects of prophylactic intravenous antibiotics and antimicrobial-coated suture in the prevention of surgical site infection in pediatric groin surgeries. Methods The study aimed to determine the effect of antimicrobial-coated sutures on postoperative surgical site infections compared with prophylactic intravenous antibiotics. This was a prospective comparative randomized study carried out on pediatric patients who were operated for uncomplicated inguinal hernias and hydroceles at the pediatric surgery unit of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, between 1st May 2016 and 31st August 2017. At UNTH Enugu all patients undergoing herniotomy received a single-dose prophylactic intravenous ampicillin/cloxacillin antibiotic combination. This study compares the effectiveness of a single-dose prophylactic intravenous ampicillin/cloxacillin combination and triclosan-coated Vicryl suture (Vicryl-plus) in preventing surgical site infection in day-case groin surgeries in children. Vicryl sutures used were of the Ethicon brand by Johnson and Johnson, while ampicillin/cloxacillin used was Labaclox from Laborate Pharmaceuticals, India. Ethical clearance was obtained from the Hospital Research and Ethics Committee of the University of Nigeria Teaching Hospital, Ituku/Ozalla. Written informed consent was obtained from the patients’ parents or guardians. Subject Selection Participants were included in the study if they were patients aged 2 months to 15 years, were admitted for an elective groin surgical procedure, had uncomplicated inguinal hernias or hydroceles, and informed consent was obtained from parents or responsible caregivers. Exclusion criteria included patients aged less than 2 months, presence of generalized debilitating disease, sickle cell disease patients irrespective of their status, history of use of antibiotics within the past seven days, history of allergy to penicillin antibiotics, associated undescended testis, and those for whom the parents or caregivers were not willing to give consent. Participants who met the study criteria were recruited consecutively. A research assistant conducted simple random sampling using a double-blind approach. Eight-six (86) sealed envelopes were prepared, forty-three (43) containing folded papers labeled A and forty-three (43) containing folded papers labeled B. Group A represented participants who would be on Vicryl-plus, while Group B represented those who would be on intravenous antibiotics. The envelopes were mixed thoroughly in a bag before a participant was asked to pick one, and the process was repeated for every patient to maintain randomization. After it was picked, the envelope was not returned to the bag. Participants were grouped according to the envelope they picked up. Sample Size Calculation A pilot study at UNTH Enugu showed an average of 96 (SD 7.75, approximated to 8) for uncomplicated inguinal hernia and hydrocele surgeries per year. Armed with information, sample size (n) was calculated using the formular [ 5 ] where Zɑ = 1.96, Zß = 0.84, δ = 8, and d = 5. The estimated sample size was about 40 per group. The total sample size was set at 80, with 6 extra participants added for attrition, resulting in a final sample size of 86. Pre-operative preparation Patients who had a respiratory tract infection, diarrhea, or fever were treated before joining the study. Following the diagnosis, caregivers were counseled on the diagnosis and treatment plan explained to them. The patient's hemoglobin levels and genotypes (for those of age six months and above) were obtained. Those with hemoglobin levels of less than 9g/dl had their hemoglobin level optimized, while patients with SS genotypes were excluded. Patients for the study had their biodata, history, and clinical examination findings documented in their folders at first presentation to the pediatric outpatient clinic. The anesthesiologists reviewed the patients and confirmed their fitness for general anesthesia. Informed consent was obtained for the study and for the surgery. Pre-admission information given to the caregiver included: the date and time of the surgery, preoperative fasting guidelines (6 hours for solid foods, 4 hours for breastmilk or formula, and 2 hours for clear fluids using 8 am as the reference time), and advice on personal hygiene. They were also notified of the possibility of admission for observation should it become necessary post-operatively; otherwise, patients would be discharged home following full recovery from anesthesia, and were free to report to the Children's Emergency Room if they developed any problems related to the surgery at home. This was communicated to the parents and caregivers in a written leaflet. Surgical technique The surgeries were done under general anesthesia (GA) with endotracheal intubation and multi-channel monitoring. Participants in Group B received a single dose of ampicillin/cloxacillin antibiotics (50mg/kg) 30 minutes before skin incision. The surgeon, assistant, and scrub nurse were scrubbed and gowned appropriately. Each patient was positioned supine, and the operation fields were cleaned with 0.5% chlorhexidine solution in water and subsequently dried with sterile gauze. The skin preparations were completed with 7.5% povidone iodine solution. A low transverse inguinal skin crease incision was made (about 3-4cm length) with the medial end above and lateral to the pubic tubercle. Hemostasis was achieved with electrocautery. The incision was deepened with diathermy (in cutting mode with needle point electrode) through the Camper’s and Scarpa’s fasciae until the external oblique aponeurosis was seen. Further dissection inferiorly and laterally on the external oblique was done to expose the external inguinal ring, and the spermatic cord was identified and delivered into the wound. For older patients, the external oblique muscle aponeurosis was opened in the direction of its fibers up to the deep ring. The coverings of the cord were bluntly dissected on the antero-medial surface to expose the hernia/hydrocele sac (patent processus vaginalis). The vas deferens and spermatic vessels were identified and protected from injury. The sac was then divided between two artery forceps, and the proximal segment of the sac was dissected proximally up to the internal ring (until preperitoneal fat was seen). The empty sac was twisted and transfixed with either 3/0 Vicryl Plus or 3/0 standard Vicryl, depending on the study group. Transfixing and ligation of the hernia or hydrocele sac was done with Vicryl-plus for Group A, and standard Vicryl for Group B. The distal end of the sac was completely or partly excised, and the testis was returned to its hemiscrotum. Wound closure Patients in study Group A had their superficial fasciae approximated with Vicryl plus 3/0, and a continuous subcuticular closure of the skin was performed with Vicryl plus 3/0. In Group B, the superficial fasciae were approximated with standard Vicryl3/0, and a continuous subcuticular closure of the skin was performed with standard Vicryl 3/0. Wounds in both groups were cleaned with an antiseptic solution and dried before application of dry gauze wound dressing. Postoperative care Post-operatively, every patient received 15mg/kg of oral paracetamol, either as syrup or tablets, eight-hourly for three days. Patients were discharged home the same day (Day case surgery) after full recovery from anesthesia with stable vital signs and general conditions, and scheduled for follow-up at the Pediatric Surgical Out-Patient clinic. After full recovery from anesthesia, patients with stable vital signs and a satisfactory general condition were discharged home on the same day. Caregivers received instructions on the discharge process and monitoring at home for any postoperative complications. Every patient was scheduled for follow-up visits at the Pediatric Surgical Outpatient Clinic. The surgical wounds were examined after 7, 14, and 30 days postoperatively. Patients were followed up for a period of 6 weeks, during which wound healing was assessed through regular clinical examinations and documentation of any signs of infection or wound breakdown. Contact phone numbers were obtained from Caregivers in case of any failed appointments. The wounds were assessed for the primary endpoints, incisional (superficial and deep) surgical site infections, in line with the Centre for Disease Control (CDC) criteria for defining surgical site infections, and for wound dehiscence. All patients were evaluated by another pediatric surgical Senior Registrar who was blinded to the study groups. Data Collection A proforma was used for data collection. Data collected included: age, sex, hospital number, weight, phone number, diagnosis, investigations, surgical procedure, treatment group, and postoperative wound complications. Statistical Analysis The data were entered into and analyzed with IBM SPSS (Statistical Package for Social Sciences), version 21.0 (IBM Corp, Armonk, NY, USA). Median values and standard deviation were obtained for age. Means were compared using the Student's t-test. In cases where the data were skewed, such as age, the Mann-Whitney U-test was employed. A chi-square test was conducted to assess the homogeneity of proportions and to examine the independence between categorical variables of interest. The level of statistical significance was set at a P-value of less than 0.05. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for cohort studies to ensure completeness, transparency, and methodological rigor in reporting. Results Eighty-six patients participated in this study, and none defaulted. Of the 86 patients, 63(73.3%) were males, and 23(26.7%) were females, giving a male-to-female (M:F) ratio of about 2.7:1. (Table 1) Table 1: Sex distribution of patients in the two study groups The majority of the participants in the Vicryl-plus group (68.8%) as well as the antibiotic group (83.3%) were males (x 2 =2.802, p=0.094) The overall mean age was 4.2±3.7years (Range: 0.2-15years). The mean age in the Vicryl-plus group was 4.1±3.8 (Range: 0.2-15years) and the mean age in the antibiotic group was 4.4±3.6years (Range: 0.3-15years), (Mann-Whitney U-test, p=0.710). The median age in both the Vicryl-plus and antibiotic groups was 3years (Table 2). A total of 96 groin surgeries were performed in 86 patients; 10 had bilateral inguinal hernias. Of 96 groin surgeries performed, 48 were in the Vicryl-plus group and 48 in the antibiotic group. The age distribution of patients who underwent surgery in both treatment groups showed that the majority of procedures 32 (66.7%) were performed on patients aged five years and younger. In contrast, the smallest proportion in both groups was observed among patients aged eleven years and above, as shown in Table 3. Statistical analysis indicated that this variation in age distribution between the groups was not significant, with a chi-square value of 0.183 and a p-value of 0.913. Forty-one (47.7%) of the patients had unilateral inguinal hernias, 10 (11.6%) had bilateral inguinal hernias, and all 35 (40.7%) cases of hydroceles were unilateral. The 10 cases of bilateral inguinal hernias were seen in the age group aged 2months-5years. The majority of the unilateral inguinal hernias, 30 (34.9%), and hydroceles, 19 (22.1%), were right-sided, 11 (12.8%), and hydroceles, 16 (18.6%), were on the left (Figure 1) and (Table 4) Out of the 96 surgeries performed, the highest proportion performed in the Vicryl-plus group, 24\48 (50.0%) and the antibiotic group, 16\48(33.3%), were for right-sided inguinal hernias. Fewer surgeries were performed on the left 5\48 (10.4%) in the Vicryl-plus group and 8\48 (16.7%) in the antibiotic group. This difference was not statistically significant. (x 2 =7.619, p =0.055). The overall mean hemoglobin value of participants was 11.6±1.4g/dl (Range: 9.2-16.1). For the Vicryl-plus group, it was 11.5±1.3g/dl, the antibiotic group was 11.8±1.4g/dl (Student t=1.333, p=0.186). Wound outcome Overall, two sets of complications were recorded and occurred in 4 (4.2%) participants. Of these, 1 (1%) was a superficial surgical site infection, and this was in the antibiotic group 1/48 (2.1%). No infection was observed in the Vicryl-plus group. Three postoperative seromas occurred, 2.1% (1/48) in the Vicryl-plus group; 4.2% (2/48) in the antibiotic group. The difference was not statistically significant (x 2 =0.344, p-0.557). (Table 5) The superficial surgical site infection was detected on day 4 post-operation and resolved within 7 days on alternate-day saline dressings. Seromas were diagnosed at the first postoperative visit, and all cases resolved spontaneously. Discussion This study primarily compared the effect of prophylactic intravenous antibiotics and antimicrobial-coated suture in the prevention of surgical site infection in pediatric groin surgeries. The predominance of participants aged 5 years and younger aligns with previous studies on pediatric inguinal hernia by Usang et al. [ 6 ] and Shah et al. [ 7 ] Another observation from the study was that inguinal hernia and hydroceles occurred more on the right side, which agrees with similar studies on inguinal hernia and hydroceles. [ 8 , 9 ] This is due to the delayed descent of the right testicle during the intra-uterine life. This study also demonstrated that there were more cases of inguinal hernias than hydroceles. This is likely due to the spontaneous regression of some hydroceles before the age of two years. [ 10 ]. There is a predominance of males with inguinal hernia and hydroceles than females, which is in keeping with the observations made by Parveen et al. [ 11 ] and Erdogan et al. [ 12 ] in their studies involving inguinal hernias and hydroceles. The male-to-female ratio of 2.7:1 in the present study is slightly lower than the 3.6:1 reported by Erdogan et al. [ 13 ] This difference in ratio may likely be due to the smaller sample size of this study when compared to the Erdogan et al. study, where 3776 children were studied. The overall low incidence of surgical site infection of 1% noted in this study may be accounted for by the effectiveness of both antimicrobial agents used in reducing surgical site infection. A study by Ibrahim et al in Kano on open herniotomy in 428 children documented wound infection rate of up to 8.73% without use of any antimicrobial agent during the surgery [ 13 ] while a comparative study by Usang et al. in Ile-Ife Nigeria reported that use of prophylactic antibiotic significantly reduced the incidence of surgical site infection when compared with the study arm that did not receive any antimicrobial agent during herniotomy. [ 4 ] However, the studies by Ekpemo et al. [ 14 ] in Nigeria and Vaze et al. [ 15 ] in India observed a lower incidence of surgical site infections in those who received preoperative antibiotics compared to those who did not receive antibiotics during herniotomies, but the findings were not statistically significant. Renko et al., working on clean pediatric surgeries in Finland, reported a surgical site infection rate of 3% in the study group when triclosan-coated suture was used in the surgical wounds, and 6% rate of wound infection when wounds were closed with standard suture without the use of antibiotics. [ 16 ] Similarly, in a single-arm study by Samra et al., 149 participants with clean surgical wounds closed with triclosan-impregnated suture recorded a surgical site infection rate of 0.7%, [ 17 ] which is comparable to the findings in this study in wounds closed with Vicryl plus suture. Likewise, another study in Egypt discovered that triclosan-coated sutures reduced the rate of surgical site infection from 15% to 7%, although the study was in adults with clean surgical wounds. [ 18 ] This buttresses the findings in the present study demonstrating the value of triclosan-coated suture in reducing surgical site infections. Ahmed et al., in their systematic review and meta-analysis on triclosan-coated suture, also reported the effectiveness of triclosan-coated sutures in reducing surgical site infections in clean surgical wounds, as was obtained in this study and in contaminated surgical wounds. [ 19 ] In pediatric cerebrospinal shunt surgery, Rozzelle et al. [ 20 ] demonstrated a 4.3% rate of surgical site infection when antimicrobial suture was used for wound closure and 21% rate of surgical site infection when this technique was not used. This observation agrees with in vitro and in vivo studies on triclosan-coated sutures, which showed that triclosan can inhibit bacterial colonization of sutures and eliminate bacteria associated with surgical site infections. [ 21 , 22 ] The study indicates that seroma can occur following open herniotomy irrespective of prophylactic intravenous antibiotic or triclosan-coated suture, with an overall incidence rate of 3.1%. This rate contrasts with findings by Askarpour et al., who reported a 0.4% rate of seroma [ 23 ] and Ibrahim et al., who documented a 1.32% rate of seroma during herniotomy in children. [ 24 ] The observance by Askarpour et al. could be due to the retrospective nature of their study, with attendant difficulties with data retrieval. The main limitations of this study were the relatively small sample size and its single-institution nature. Conclusion The results of the study indicate that triclosan-coated suture and prophylactic intravenous antibiotics reduced the incidence of surgical site infections in pediatric inguinal incisions for hydroceles and hernias. The observed difference in favor of triclosan-coated suture was not statistically significant. The occurrence of wound seroma was not significantly different between the two groups. Surgical site infections that occurred resolved without significant morbidity following outpatient wound care. Recommendations Based on the findings of this study, triclosan-coated Vicryl sutures alone may serve as an effective alternative to prophylactic intravenous antibiotics in settings where surgical site infection rates remain elevated following pediatric groin surgeries. This approach may help to reduce antibiotic usage, thereby minimizing the risk of antibiotic-resistant bacteria and drug-induced side effects. Further research with larger sample sizes and multi-institutional designs is recommended to strengthen the evidence base. Declarations Author Contribution s: EIN, EPN, UOE, and SOE, contributed to the conception, data collection, analysis of the work, and writing of the paper. CCA, ICO, ONA, and IOI were involved in the first critical review of the paper. All authors undertook the final revision of the paper. Ethical approval: Ethical clearance was obtained from the University of Nigeria Teaching Hospital Research and Ethics Committee. Approval number: NHREC/05/01/2008B-FWA00002458-1RB00002323, Date: 21 st October, 2015. Informed consent: Written informed consent was obtained from the patients’ parents or guardians before enrolment into the study. Declaration of Helsinki: The study was conducted according to the ethical principles of the Helsinki Declaration of 1975, as revised in 2013. Availability of research data: The data is available upon request through the corresponding author. Clinical Trial Number: Not Applicable. Funding or financial support: Authors did not receive any funding or financial support for this study. Conflict of Interest Statement. The authors declare no conflict of interest. Acknowledgement: We wish to acknowledge the contributions of the research assistants who helped with data collection. We also appreciate the anesthesiologists and nurses who assisted in the surgeries and post-operative care of the patients. We thank the patients and their parents/caregivers, whose consent made this study possible. We acknowledge the use of the Grammarly App for ensuring grammatical correctness. References National Institute for Health and Care Experience (NICE) guideline. Surgical site infections: prevention and treatment. United Kingdom: NICE; 2008, 4-29 Owens CD, Stoessel K. Surgical site infection: epidemiology, microbiology and prevention. J Hosp Infect. 2008 ; 70(suppl 2): 3-10. 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Omid A, Diana ND, Vahid M. New technique for herniotomy in children-Clinical trial running title: Non-ligation herniotomy in children. Advances in Surgical Sciences . 2014; 2(1): 1-4. Natasha F, Behrouz B. Pediatric hydrocele: A comprehensive review. Cln Surg . 2017; 2 : 1-6 Amanollahi O, Nejad ZG, Samadzagen A. Comparison of two method of hydrocele repair in children. Iranian Journal of pediatric surgery . 2019; 5(1): 33-37 Parveen Z, Khan S, Sultan S, Nahar MN, Nessa G. Pattern of children presenting with inguinal hernia and hydrocele- Experience in a Tertiary level Hospital. JAFMC Bangladesh . 2017; 13(1): 46-50 Erdogan D, Karaman I, Aslan MK, Karaman A, Cavusoglu YH. Analysis of 3776 pediatric inguinal hernia and hydrocele cases in a tertiary centre. J Ped Surg . 2013; 48 : 1767-1772 Ibrahim M, Ladan MA, Abdussalam US, Getso KI, Mohammad MA, Chukwuemeka AL et al. Open inguinal herniotomy: Analysis of variations. Afr J Paediatr surg . 2015; 12(2): 131-135 Ekpemo SC. The use of prophylactic antibiotics in day case herniotomy at University of Nigeria Teaching Hospital Enugu Nigeria (dissertation). West African College of Surgeons, 2016. Vaze D, Samujh R, Narasimha Rao KL. Risk of surgical site infection in paediatric herniotomies without any prophylactic antibiotics: A preliminary experience. Afr J Paediatr Surg . 2014; 11 : 158-161. Renko M, Poalanne N, Tapiainen T, Hinkkainen M, Pokka T, Kinnula S et al. Triclosan-containing sutures versus ordinary sutures for reducing surgical site infections in children: a double blind randomized controlled trial. Lancet Infect Dis . 2017; 17(1): 50-57. Samra SS, Jagad V, Mahajan M, Randhawa MS, Trehan C. Impact of using triclosan impregnated sutures on incidence of surgical site infection: a real World Indian study. Int Surg J . 2018; 5(2): 647-652 Galal I, El-Hindawy K. Impact of using triclosan-antibacterial sutures on incidence of surgical site infection. Am J Surg . 2011; 202(2): 133-138. Ahmed I, Boulton AJ, Rizvi S, Carlos W, Dickenson E, Smith NA. The use of triclosan-coated sutures to prevent surgical site infection: a systematic review and meta-analysis of the literature. BMJ Open . 2019; 9(9): 1-12 Rozzelle CJ, Leonardo J, Li V. Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective double-blinded randomized controlled trial. J NeurosurgPediatri . 2008; 2(2): 111-117 Rothenburger S, Spangler D, Bhende S, Burkley D. In vitro antimicrobial evaluation of coated vicryl-plus antibacterial suture (coated polyglactin 910 with triclosan) using zone of inhibition assays. Surg Infect . 2002; 3(suppl 1): 79-87 Ming X, Rothenburger S, Nichols MM. In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture. Surg Infect . 2008; 9 : 451-457 Askarpour S, Peyvasteh M, Hazhir JH, Mehdianzadeh F. Recurrence and complications of paediatric inguinal hernia repair over 5years. Annals of pediatric surgery . 2013; 9 : 58-60 Ibrahim M, Getso KI, Mohammad MA, Akhparov NN, Aipov RR. Herniotomy in resource-scarce environment: comparison of incisions and techniques. Afr J Paediatr Surg . 2015; 12(1): 45-50s Tables Tables 1 to 5 are available in the supplementary files section Additional Declarations No competing interests reported. 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Obinna","middleName":"","lastName":"Anikwe","suffix":""},{"id":607481978,"identity":"a8523f01-05ed-41cf-ad67-4aa6acd7717c","order_by":6,"name":"Innocent Igwilo","email":"","orcid":"","institution":"Federal University Teaching Hospital, Owerri Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Innocent","middleName":"","lastName":"Igwilo","suffix":""},{"id":607481979,"identity":"c5ad5c1a-f689-4981-b277-371c04058e28","order_by":7,"name":"Sebastian Ekenze","email":"","orcid":"","institution":"University of Nigeria Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sebastian","middleName":"","lastName":"Ekenze","suffix":""}],"badges":[],"createdAt":"2026-02-17 15:55:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8902559/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8902559/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104997096,"identity":"8eaa2ec6-810a-4955-818f-b1446ff736fb","added_by":"auto","created_at":"2026-03-19 16:17:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28113,"visible":true,"origin":"","legend":"\u003cp\u003ePie chart showing the diagnosis of the patients\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8902559/v1/c050579fce36acc4bc085127.png"},{"id":104997098,"identity":"a0057622-b1fb-4334-9b2b-137d6f136ca8","added_by":"auto","created_at":"2026-03-19 16:17:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":517537,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8902559/v1/9a0abf1a-6668-49a3-80b2-b4e7b6eb590e.pdf"},{"id":104997097,"identity":"8ffffef6-c726-44c8-817d-f4c8f112c14c","added_by":"auto","created_at":"2026-03-19 16:17:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15584,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8902559/v1/1f2244b731a2275a93507746.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A comparative study of the effect of prophylactic intravenous antibiotics and triclosan-coated sutures in the prevention of surgical site infection in pediatric groin surgeries","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSurgical site infections constitute up to 20% of all healthcare-associated infections, and at least 5% of patients undergoing a surgical procedure develop a surgical site infection [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is known that this incidence varies depending on the surgical procedure, the surveillance criteria used, and the quality of data collection [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Antibiotic prophylaxis is of significant benefit where the surgical site infection rate is greater than 5% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAt the University of Nigeria Teaching Hospital, single-dose prophylactic antibiotics are used routinely for pediatric groin surgeries. The prevailing environment and risk of surgical site infections fuel this practice. Despite the prevalence of surgical site infection in our environment, there is a paucity of research on the prevention of surgical site infection in children, especially in the use of antimicrobial-coated sutures for surgical wound closure. This intervention has been reported to be effective in preventing surgical site infection. Hence, this study compares the effects of prophylactic intravenous antibiotics and antimicrobial-coated suture in the prevention of surgical site infection in pediatric groin surgeries.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study aimed to determine the effect of antimicrobial-coated sutures on postoperative surgical site infections compared with prophylactic intravenous antibiotics. This was a prospective comparative randomized study carried out on pediatric patients who were operated for uncomplicated inguinal hernias and hydroceles at the pediatric surgery unit of the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, between 1st May 2016 and 31st August 2017. At UNTH Enugu all patients undergoing herniotomy received a single-dose prophylactic intravenous ampicillin/cloxacillin antibiotic combination. This study compares the effectiveness of a single-dose prophylactic intravenous ampicillin/cloxacillin combination and triclosan-coated Vicryl suture (Vicryl-plus) in preventing surgical site infection in day-case groin surgeries in children. Vicryl sutures used were of the Ethicon brand by Johnson and Johnson, while ampicillin/cloxacillin used was Labaclox from Laborate Pharmaceuticals, India. Ethical clearance was obtained from the Hospital Research and Ethics Committee of the University of Nigeria Teaching Hospital, Ituku/Ozalla. Written informed consent was obtained from the patients\u0026rsquo; parents or guardians.\u003c/p\u003e\n\u003cp\u003eSubject Selection\u003c/p\u003e\n\u003cp\u003eParticipants were included in the study if they were patients aged 2 months to 15 years, were admitted for an elective groin surgical procedure, had uncomplicated inguinal hernias or hydroceles, and informed consent was obtained from parents or responsible caregivers. Exclusion criteria included patients aged less than 2 months, presence of generalized debilitating disease, sickle cell disease patients irrespective of their status, history of use of antibiotics within the past seven days, history of allergy to penicillin antibiotics, associated undescended testis, and those for whom the parents or caregivers were not willing to give consent.\u003c/p\u003e\n\u003cp\u003eParticipants who met the study criteria were recruited consecutively. A research assistant conducted simple random sampling using a double-blind approach. Eight-six (86) sealed envelopes were prepared, forty-three (43) containing folded papers labeled A and forty-three (43) containing folded papers labeled B. Group A represented participants who would be on Vicryl-plus, while Group B represented those who would be on intravenous antibiotics. The envelopes were mixed thoroughly in a bag before a participant was asked to pick one, and the process was repeated for every patient to maintain randomization. After it was picked, the envelope was not returned to the bag. Participants were grouped according to the envelope they picked up.\u003c/p\u003e\n\u003cp\u003eSample Size Calculation\u003c/p\u003e\n\u003cp\u003eA pilot study at UNTH Enugu showed an average of 96 (SD 7.75, approximated to 8) for uncomplicated inguinal hernia and hydrocele surgeries per year. Armed with information, sample size (n) was calculated using the formular [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAXoAAABSCAYAAABaKB9/AAAAAXNSR0IArs4c6QAAAARnQU1BAACxjwv8YQUAAAAJcEhZcwAAFiUAABYlAUlSJPAAAAvASURBVHhe7d3PixvlAwbwJ9+7wmxuCkV2elkobMFZe6nCCjph683WbMGDB6HO9OTBXVntqfXHBE9CNytU6KUkwQoiZt0oWDBLsTVKcpAedAapHhNH8Q+Y78G8L2/ezGST3Ww3fft8YKD7vm8mk8nkmTfvvJPmkiRJQERExvqfXkBERGZh0BMRGY5BT0RkOAY9EZHhGPRERIZj0BMRGY5BT0RkOAY9EZHhGPRERIZj0BMRGY5BT0RkOAY9EZHhGPRERIZj0BMRGY5BT0RkOAY9EZHhGPRERIZj0BMRGY5BT0RkOAY9EZHhGPRERIZj0BMRGY5BT0RkOAY9EZHhGPRERIZj0BMRGY5BT0RkOAY9EZHhGPRERIZj0BM9pKIoQi6XG1iiKNKbETHoZ1mn04Hv+3oxTcHu7i5KpZJe/NCIogi2bSMIAiRJgiRJEAQBbNtm2NMQBv0UVKtVFAoF2auam5vD6uoqdnd39aYolUpDvbC0dr1eD6+//jqee+45oB9M+uP2Wh4m6v4bZ0kL6e3tbayurso2c3Nz8H0/NfgWFhbw4Ycfolqt6lXSuPs87f1D/0Sdy+Xwzjvv6FWpxD4Q60s7VoSbN2/Ctm2sra3JsrW1Ndi2jZs3b8oyIjDoD873fZw/fx6NRgOO48B1XczNzaFWq+HZZ59NDSQAsCwLruvCdV089thjejUuXryIOI6xurqqV1EK3/dx5swZ1Go1+T4AQLlchuM46PV6A+3z+TzefvvtzBMBADzxxBOwLAvQ3i99SXv/AOCHH34AALzyyit61ViOHTsmn0O3traG3377TS8GAPz+++96ET3qEtq3IAgSAIllWUmz2Ryo29raSgAkAAbqxGNc1x1or2o2mwmAJAgCvWqkdrudWJaVAEg8z9OrH3qe58n93W63ZXm73U7d191uN3EcJ3NfdrvdBEBSLBb1Kqnb7SbFYjEBkGxsbCTdbldvksl13cSyLL04k+u6Q69BEK9vlDAMM18rPdpGHzk0km3bCYCkUqnoVUmiBJMaJOMEvfjAh2GoV2UKw1CGvOM4evWhGyeIDmJjY0M+R71eH6gT+zTt5DaqLkkSGeLqiSNNs9lMbNtOLMtKtra29Ooh4iSS9bxpDhr04ngj0s3s0I0YnyyVSoiiCL7vY25uDrlcDsePH4fv+0Nfxx808bX+hRde0KsAAC+99BIA4O+//9arMnU6HTQaDdi2jfn5eb06Va/XQ7FYRBzHsCwLOzs7ehOgP+asjmEXCgV0Oh05Fl0oFPSHzIRqtYr3338fABAEAVZWVgbqf/75ZwDAU089NVAOZRhDXOvQLS8vAwA++eQTvUqqVqt48803EYYh4jjGG2+8gaWlJXQ6Hb2pdOfOHSDjeUulEpaWlpBTriMc9FiuVqsol8uoVCp6FdHsnv5FT6xYLMqequu6steDfs913K/S6uP2Wkb1tieR1ntPK1OJnuskPcGsIQ1VpVIZep3iMWKYKWubxiHWN23jDEeJ91YfshBDOrZtD5SrxDBZ1hCL2LdiPa7rym9yo/a3eJx+fIqhJPSPX7HtjuPIukl79OK91V8/kZB+5MwAEYjiQ6AOY6gf/nG+RidHEPTdblcGgrqNewX9qDHlNOq1gKwhJBFm6IelCJ9mszkQPFnbNA6xjmlS9+Gok3pW0ItyfahHJ7ZdD231GNT3rdjvlmWlDrFZljU0hCbWp58g2u32wPswSdCLdeqvnUg1fOTMCPVDlvZB2k/P90FSe9lqQGUFved5A4EcBEHieV7qaxfq9bpsv7GxoVdLYhw67aKjuICXtk2TyAqigxDhlxWmQlrQj9Ob9zxvYB8GQZAEQSCDVnQmskI07RpMojy33gkR60s78WRdUBbS9q84lvSTEJFuup/MKRIHsd4rErICcxaoX/f1D23WdqcNrehtVOq3Gj1odGJ9aQGTKNs76vlUD+LbkboP9Z62Li3o1ZNm1uPVNvr2qnVZ3yTUcE47mavPK9aXNUSUKCc2/ZhJUoJerC/rJESkmtmLsUI+n9eLZprv+yiXywCASqWC06dP601SiQu6nufJC2qvvfaa1uo/4maqOI7hOA6uXr2qN0mlX8QUxEXjWSEuLKK/DxcXF/Umezp9+rScf37y5MnU+xkWFhZgWRYcx0G9XgcAPP/88wCAP//8EwDgOE7mMahu17179+S/P/vsM9i2PVAv1vfMM8/IMt3S0pJelOnKlSsAgPX19aGbqmb1ojodnZkP+mmZ5M7L/XxQer0eCoUCyuUyLMtCs9mc6GanS5cuwbZtbG5uYnV1FZ7n4d13302djXHx4kW0Wi1YloVr165lBtG4Hn/8cb1opJ2dHfS/DcpF0MuzZgBl6XQ6OH/+PNA/6U2yD3U3btyA53lAPxD1mTKXLl1CHMeo1WpYWVmB53lYX19HFEW4f/8+sI+ORhRFaLVaePHFFwfKxfpGSZs1lCXtPdjvPifzPTJBf5g6nQ5OnTolp0XeunVr7J68cPnyZYRhCN/3ZY/2ypUrQ0FTKpVQq9UAAF9++eVEvd20k8Ys6fV6crqj67rY3NzUm0wkn89jc3MT9XodlmWh1Wrh5Zdflvvh8uXLsCwLxWIR29vbKJfLCIIA8/PzOHHiBLCPfXb37l0g5VvSsWPHBv5O888//+hFRFPxyAT9qB6QvkzSI+p0OlheXkYYhnAcB3fu3JkofIVvv/0W6N+yL3q0169fH2izvb2N9fV1AMDW1tbYJxPbtgFlbrfu66+/1ouORKFQQBzHsG0bN27c0Kv3bWVlBb/++issy0IYhnI/3Lt3D3Eco9Vq4cyZMwCA7777DgDw5JNPAgBarVZm2Ks/nbCwsAAA+OKLLwAAp06dknVqfaPRGChX/fTTT3oR0VQ8MkF/GKIowvLyMuI4hud52NnZGeqBj+v7779Hs9mUf3ueh/n5eRkmnU4Hr776qqy7cOGCbLuXYrEIAPj444/1KvR6PTkefpR835fDUZ9//vm+9yP6Nz8tLS0NBHQ+n5fj43/88QfQP8GpNxhtbW3h6aefxu7uLhYXF+UJ8tNPP5VtVOLHw1zXldv7zTffoFgsDm2/ur60H1KLomjkSYDoQPSrs7Mia3aKsFf9gyBme0yyDXttd9oMEvU3W7JmIY2i/jyCOmVTn7+dtU3j0GeFTEKdcZQ1M2gUfZ+J16ROvVVn0ahTNcVPFSBldo469VKfKpn2W0aivd5WUOfeqzNrwjDc9zx6onHM7JGzVyDuVX/Y0qbmZS3qNu613aI+K6QmWdTAUENLXSzLmnh65bSJoJ5kUbdVD3p16qlt2wMhqt9vsNe0x1F3xkKbwy7u7Rg1519dn6PcGSv+BoOeDgGHbvbp9u3betFUiCmBP/74o151ICsrK2i323IYB/3nunXr1kSzPR4Gi4uLaLVaKBaLCMMQrVYLjuOgUqngvffeG2j7yy+/AEDm7B5xMdd1XYRhiEajgb/++gue5w3NrKrVanv+RtHm5iYqlQocx0Gr1ZI/b91sNnHu3Dm9OdFU5JL/egv0gJRKJayvr8N13cyLvsePH0cYhuh2u0NjvTRd4r6Her2eeZ/BLMj1/9MRflxpP9ijn0FvvfUWoMzEocNTrVZh2/ZMhzzRQTHoZ9DZs2dhWZacqkeHY3t7G3Ecy7tMiUzFoD8id+/eRaFQkL8Jr8rn8/jggw9Qq9Uy53DTwX311VdwHCdzfP6oif+LeD93ahOpGPRHJI5jNBoNNBoN/Pvvv3o1Lly4ANd1+R89HxJx/8C1a9f0qplx//59eYwQHQQvxs6wKIrw0UcfHfinAGjY7u4ubt++jbW1Nb2KyDgMeiIiw3HohojIcAx6IiLDMeiJiAzHoCciMhyDnojIcAx6IiLDMeiJiAzHoCciMhyDnojIcAx6IiLDMeiJiAzHoCciMhyDnojIcAx6IiLDMeiJiAzHoCciMhyDnojIcAx6IiLDMeiJiAzHoCciMhyDnojIcAx6IiLDMeiJiAzHoCciMhyDnojIcAx6IiLD/R8xbBtbWysowQAAAABJRU5ErkJggg==\"\u003e\u003c/p\u003e\n\u003cp\u003ewhere Zɑ = 1.96, Z\u0026szlig; = 0.84, \u0026delta;\u0026thinsp;=\u0026thinsp;8, and d\u0026thinsp;=\u0026thinsp;5. The estimated sample size was about 40 per group. The total sample size was set at 80, with 6 extra participants added for attrition, resulting in a final sample size of 86.\u003c/p\u003e\n\u003cp\u003ePre-operative preparation\u003c/p\u003e\n\u003cp\u003ePatients who had a respiratory tract infection, diarrhea, or fever were treated before joining the study. Following the diagnosis, caregivers were counseled on the diagnosis and treatment plan explained to them. The patient\u0026apos;s hemoglobin levels and genotypes (for those of age six months and above) were obtained. Those with hemoglobin levels of less than 9g/dl had their hemoglobin level optimized, while patients with SS genotypes were excluded. Patients for the study had their biodata, history, and clinical examination findings documented in their folders at first presentation to the pediatric outpatient clinic. The anesthesiologists reviewed the patients and confirmed their fitness for general anesthesia.\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained for the study and for the surgery. Pre-admission information given to the caregiver included: the date and time of the surgery, preoperative fasting guidelines (6 hours for solid foods, 4 hours for breastmilk or formula, and 2 hours for clear fluids using 8 am as the reference time), and advice on personal hygiene. They were also notified of the possibility of admission for observation should it become necessary post-operatively; otherwise, patients would be discharged home following full recovery from anesthesia, and were free to report to the Children\u0026apos;s Emergency Room if they developed any problems related to the surgery at home. This was communicated to the parents and caregivers in a written leaflet.\u003c/p\u003e\n\u003cp\u003eSurgical technique\u003c/p\u003e\n\u003cp\u003eThe surgeries were done under general anesthesia (GA) with endotracheal intubation and multi-channel monitoring. Participants in Group B received a single dose of ampicillin/cloxacillin antibiotics (50mg/kg) 30 minutes before skin incision. The surgeon, assistant, and scrub nurse were scrubbed and gowned appropriately. Each patient was positioned supine, and the operation fields were cleaned with 0.5% chlorhexidine solution in water and subsequently dried with sterile gauze. The skin preparations were completed with 7.5% povidone iodine solution. A low transverse inguinal skin crease incision was made (about 3-4cm length) with the medial end above and lateral to the pubic tubercle. Hemostasis was achieved with electrocautery. The incision was deepened with diathermy (in cutting mode with needle point electrode) through the Camper\u0026rsquo;s and Scarpa\u0026rsquo;s fasciae until the external oblique aponeurosis was seen.\u003c/p\u003e\n\u003cp\u003eFurther dissection inferiorly and laterally on the external oblique was done to expose the external inguinal ring, and the spermatic cord was identified and delivered into the wound. For older patients, the external oblique muscle aponeurosis was opened in the direction of its fibers up to the deep ring. The coverings of the cord were bluntly dissected on the antero-medial surface to expose the hernia/hydrocele sac (patent processus vaginalis). The vas deferens and spermatic vessels were identified and protected from injury. The sac was then divided between two artery forceps, and the proximal segment of the sac was dissected proximally up to the internal ring (until preperitoneal fat was seen). The empty sac was twisted and transfixed with either 3/0 Vicryl Plus or 3/0 standard Vicryl, depending on the study group. Transfixing and ligation of the hernia or hydrocele sac was done with Vicryl-plus for Group A, and standard Vicryl for Group B. The distal end of the sac was completely or partly excised, and the testis was returned to its hemiscrotum.\u003c/p\u003e\n\u003cp\u003eWound closure\u003c/p\u003e\n\u003cp\u003ePatients in study Group A had their superficial fasciae approximated with Vicryl plus 3/0, and a continuous subcuticular closure of the skin was performed with Vicryl plus 3/0. In Group B, the superficial fasciae were approximated with standard Vicryl3/0, and a continuous subcuticular closure of the skin was performed with standard Vicryl 3/0. Wounds in both groups were cleaned with an antiseptic solution and dried before application of dry gauze wound dressing.\u003c/p\u003e\n\u003cp\u003ePostoperative care\u003c/p\u003e\n\u003cp\u003ePost-operatively, every patient received 15mg/kg of oral paracetamol, either as syrup or tablets, eight-hourly for three days. Patients were discharged home the same day (Day case surgery) after full recovery from anesthesia with stable vital signs and general conditions, and scheduled for follow-up at the Pediatric Surgical Out-Patient clinic.\u003c/p\u003e\n\u003cp\u003eAfter full recovery from anesthesia, patients with stable vital signs and a satisfactory general condition were discharged home on the same day. Caregivers received instructions on the discharge process and monitoring at home for any postoperative complications. Every patient was scheduled for follow-up visits at the Pediatric Surgical Outpatient Clinic. The surgical wounds were examined after 7, 14, and 30 days postoperatively. Patients were followed up for a period of 6 weeks, during which wound healing was assessed through regular clinical examinations and documentation of any signs of infection or wound breakdown. Contact phone numbers were obtained from Caregivers in case of any failed appointments. The wounds were assessed for the primary endpoints, incisional (superficial and deep) surgical site infections, in line with the Centre for Disease Control (CDC) criteria for defining surgical site infections, and for wound dehiscence. All patients were evaluated by another pediatric surgical Senior Registrar who was blinded to the study groups.\u003c/p\u003e\n\u003cp\u003eData Collection\u003c/p\u003e\n\u003cp\u003eA proforma was used for data collection. Data collected included: age, sex, hospital number, weight, phone number, diagnosis, investigations, surgical procedure, treatment group, and postoperative wound complications.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eThe data were entered into and analyzed with IBM SPSS (Statistical Package for Social Sciences), version 21.0 (IBM Corp, Armonk, NY, USA). Median values and standard deviation were obtained for age. Means were compared using the Student\u0026apos;s t-test. In cases where the data were skewed, such as age, the Mann-Whitney U-test was employed. A chi-square test was conducted to assess the homogeneity of proportions and to examine the independence between categorical variables of interest. The level of statistical significance was set at a P-value of less than 0.05.\u003c/p\u003e\n \u003cp\u003eThis study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for cohort studies to ensure completeness, transparency, and methodological rigor in reporting.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eEighty-six patients participated in this study, and none defaulted. Of the 86 patients, 63(73.3%) were males, and 23(26.7%) were females, giving a male-to-female (M:F) ratio of about 2.7:1. (Table 1)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1: Sex distribution of patients in the two study groups\u003c/p\u003e\n\u003cp\u003eThe majority of the participants in the Vicryl-plus group (68.8%) as well as the antibiotic group (83.3%) were males (x\u003csup\u003e2\u003c/sup\u003e=2.802, p=0.094) The overall mean age was 4.2\u0026plusmn;3.7years (Range: 0.2-15years). The mean age in the Vicryl-plus group was 4.1\u0026plusmn;3.8 (Range: 0.2-15years) and the mean age in the antibiotic group was 4.4\u0026plusmn;3.6years (Range: 0.3-15years), (Mann-Whitney U-test, p=0.710). The median age in both the Vicryl-plus and antibiotic groups was 3years (Table 2).\u003c/p\u003e\n\u003cp\u003eA total of 96 groin surgeries were performed in \u0026nbsp;86 patients; 10 had bilateral inguinal hernias. Of 96 groin surgeries performed, 48 were in the Vicryl-plus group and 48 in the antibiotic group. The age distribution of patients who underwent surgery in both treatment groups showed that the majority of procedures 32 (66.7%) were performed on patients aged five years and younger. In contrast, the smallest proportion in both groups was observed among patients aged eleven years and above, as shown in Table 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analysis indicated that this variation in age distribution between the groups was not significant, with a chi-square value of 0.183 and a p-value of 0.913.\u003c/p\u003e\n\u003cp\u003eForty-one (47.7%) of the patients had unilateral inguinal hernias, 10 (11.6%) had bilateral inguinal hernias, and all 35 (40.7%) cases of hydroceles were unilateral. The 10 cases of bilateral inguinal hernias were seen in the age group aged 2months-5years. The majority of the unilateral inguinal hernias, 30 (34.9%), and hydroceles, 19 (22.1%), were right-sided, 11 (12.8%), and hydroceles, 16 (18.6%), were on the left (Figure 1) and (Table 4)\u003c/p\u003e\n\u003cp\u003eOut of the 96 surgeries performed, the highest proportion performed in the Vicryl-plus group, 24\\48 (50.0%) and the antibiotic group, 16\\48(33.3%), were for right-sided inguinal hernias. Fewer surgeries were performed on the left 5\\48 (10.4%) in the Vicryl-plus group and 8\\48 (16.7%) in the antibiotic group. This difference was not statistically significant. (x\u003csup\u003e2\u003c/sup\u003e=7.619, \u003cem\u003ep\u003c/em\u003e=0.055).\u003c/p\u003e\n\u003cp\u003eThe overall mean hemoglobin value of participants was 11.6\u0026plusmn;1.4g/dl (Range: 9.2-16.1). For the Vicryl-plus group, it was 11.5\u0026plusmn;1.3g/dl, the antibiotic group was 11.8\u0026plusmn;1.4g/dl (Student t=1.333, p=0.186).\u003c/p\u003e\n\u003cp\u003eWound outcome\u003c/p\u003e\n\u003cp\u003eOverall, two sets of complications were recorded and occurred in 4 (4.2%) participants. Of these, 1 (1%) was a superficial surgical site infection, and this was in the antibiotic group 1/48 (2.1%). No infection was observed in the Vicryl-plus group. Three postoperative seromas occurred, 2.1% (1/48) in the Vicryl-plus group; 4.2% (2/48) in the antibiotic group. The difference was not statistically significant (x\u003csup\u003e2\u003c/sup\u003e=0.344, p-0.557). (Table 5)\u0026nbsp;The superficial surgical site infection was detected on day 4 post-operation and resolved within 7 days on alternate-day saline dressings. Seromas were diagnosed at the first postoperative visit, and all cases resolved spontaneously.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study primarily compared the effect of prophylactic intravenous antibiotics and antimicrobial-coated suture in the prevention of surgical site infection in pediatric groin surgeries.\u003c/p\u003e \u003cp\u003e The predominance of participants aged 5 years and younger aligns with previous studies on pediatric inguinal hernia by Usang et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and Shah et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Another observation from the study was that inguinal hernia and hydroceles occurred more on the right side, which agrees with similar studies on inguinal hernia and hydroceles. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] This is due to the delayed descent of the right testicle during the intra-uterine life. This study also demonstrated that there were more cases of inguinal hernias than hydroceles. This is likely due to the spontaneous regression of some hydroceles before the age of two years. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. There is a predominance of males with inguinal hernia and hydroceles than females, which is in keeping with the observations made by Parveen et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and Erdogan et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] in their studies involving inguinal hernias and hydroceles. The male-to-female ratio of 2.7:1 in the present study is slightly lower than the 3.6:1 reported by Erdogan et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] This difference in ratio may likely be due to the smaller sample size of this study when compared to the Erdogan et al. study, where 3776 children were studied.\u003c/p\u003e \u003cp\u003eThe overall low incidence of surgical site infection of 1% noted in this study may be accounted for by the effectiveness of both antimicrobial agents used in reducing surgical site infection. A study by Ibrahim et al in Kano on open herniotomy in 428 children documented wound infection rate of up to 8.73% without use of any antimicrobial agent during the surgery [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] while a comparative study by Usang et al. in Ile-Ife Nigeria reported that use of prophylactic antibiotic significantly reduced the incidence of surgical site infection when compared with the study arm that did not receive any antimicrobial agent during herniotomy. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] However, the studies by Ekpemo et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] in Nigeria and Vaze et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] in India observed a lower incidence of surgical site infections in those who received preoperative antibiotics compared to those who did not receive antibiotics during herniotomies, but the findings were not statistically significant.\u003c/p\u003e \u003cp\u003eRenko et al., working on clean pediatric surgeries in Finland, reported a surgical site infection rate of 3% in the study group when triclosan-coated suture was used in the surgical wounds, and 6% rate of wound infection when wounds were closed with standard suture without the use of antibiotics. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Similarly, in a single-arm study by Samra et al., 149 participants with clean surgical wounds closed with triclosan-impregnated suture recorded a surgical site infection rate of 0.7%, [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] which is comparable to the findings in this study in wounds closed with Vicryl plus suture. Likewise, another study in Egypt discovered that triclosan-coated sutures reduced the rate of surgical site infection from 15% to 7%, although the study was in adults with clean surgical wounds. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] This buttresses the findings in the present study demonstrating the value of triclosan-coated suture in reducing surgical site infections. Ahmed et al., in their systematic review and meta-analysis on triclosan-coated suture, also reported the effectiveness of triclosan-coated sutures in reducing surgical site infections in clean surgical wounds, as was obtained in this study and in contaminated surgical wounds. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] In pediatric cerebrospinal shunt surgery, Rozzelle et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] demonstrated a 4.3% rate of surgical site infection when antimicrobial suture was used for wound closure and 21% rate of surgical site infection when this technique was not used. This observation agrees with in vitro and in vivo studies on triclosan-coated sutures, which showed that triclosan can inhibit bacterial colonization of sutures and eliminate bacteria associated with surgical site infections. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe study indicates that seroma can occur following open herniotomy irrespective of prophylactic intravenous antibiotic or triclosan-coated suture, with an overall incidence rate of 3.1%. This rate contrasts with findings by Askarpour et al., who reported a 0.4% rate of seroma [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and Ibrahim et al., who documented a 1.32% rate of seroma during herniotomy in children. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] The observance by Askarpour et al. could be due to the retrospective nature of their study, with attendant difficulties with data retrieval.\u003c/p\u003e \u003cp\u003eThe main limitations of this study were the relatively small sample size and its single-institution nature.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of the study indicate that triclosan-coated suture and prophylactic intravenous antibiotics reduced the incidence of surgical site infections in pediatric inguinal incisions for hydroceles and hernias. The observed difference in favor of triclosan-coated suture was not statistically significant. The occurrence of wound seroma was not significantly different between the two groups. Surgical site infections that occurred resolved without significant morbidity following outpatient wound care.\u003c/p\u003e\n\u003ch3\u003eRecommendations\u003c/h3\u003e\n\u003cp\u003eBased on the findings of this study, triclosan-coated Vicryl sutures alone may serve as an effective alternative to prophylactic intravenous antibiotics in settings where surgical site infection rates remain elevated following pediatric groin surgeries. This approach may help to reduce antibiotic usage, thereby minimizing the risk of antibiotic-resistant bacteria and drug-induced side effects. Further research with larger sample sizes and multi-institutional designs is recommended to strengthen the evidence base.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003es: EIN, EPN, UOE, and SOE, contributed to the conception, data collection, analysis of the work, and writing of the paper. CCA, ICO, ONA, and \u0026nbsp;IOI were involved in the first critical review of the paper. All authors undertook the final revision of the paper.\u003c/p\u003e\n\u003cp\u003eEthical approval: Ethical clearance was obtained from the University of Nigeria Teaching Hospital Research and Ethics Committee. Approval number: NHREC/05/01/2008B-FWA00002458-1RB00002323, Date: 21\u003csup\u003est\u003c/sup\u003e October, 2015.\u003c/p\u003e\n\u003cp\u003eInformed consent: Written informed consent was obtained from the patients’ parents or guardians before enrolment into the study.\u003c/p\u003e\n\u003cp\u003eDeclaration of Helsinki: The study was conducted according to the ethical principles of the Helsinki Declaration of 1975, as revised in 2013.\u003c/p\u003e\n\u003cp\u003eAvailability of research data: The data is available upon request through the corresponding author.\u003c/p\u003e\n\u003cp\u003eClinical Trial Number: Not Applicable.\u003c/p\u003e\n\u003cp\u003eFunding or financial support: \u0026nbsp;Authors did not receive any funding or financial support for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConflict of Interest Statement. The authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003eAcknowledgement:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe wish to acknowledge the contributions of the research assistants who helped with data collection. We also appreciate the anesthesiologists and nurses who assisted in the surgeries and post-operative care of the patients. We thank the patients and their parents/caregivers, whose consent made this study possible.\u003c/p\u003e\n\u003cp\u003eWe acknowledge the use of the Grammarly App for ensuring grammatical correctness.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eNational Institute for Health and Care Experience (NICE) guideline. Surgical site infections: prevention and treatment. United Kingdom: NICE; 2008, 4-29\u003c/li\u003e\n \u003cli\u003eOwens CD, Stoessel K. Surgical site infection: epidemiology, microbiology and prevention. \u003cem\u003eJ Hosp Infect. 2008\u003c/em\u003e; \u003cstrong\u003e70(suppl 2): \u003c/strong\u003e3-10.\u003c/li\u003e\n \u003cli\u003eMiserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, et al. Update with level 1 studies of the European hernia society guidelines on the treatment of inguinal hernia in adult patients. \u003cem\u003eHernia\u003c/em\u003e. 2014; \u003cstrong\u003e18\u003c/strong\u003e: 151-163.\u003c/li\u003e\n \u003cli\u003eUsang UE, Sowande OA, Adejuigbe O, Bakare TI, Ademuyiwa OA. The role of preoperative antibiotics in the prevention of wound infection after day case surgery for inguinal hernia in children in Ile-Ife, Nigeria. \u003cem\u003ePediatr Surg Int\u003c/em\u003e. 2008; \u003cstrong\u003e24(10):\u003c/strong\u003e 1181-1185.\u003c/li\u003e\n \u003cli\u003eFrieman LM, Furberg CD, Demets DL. Sample size. In: \u003cem\u003eFundamentals of clinical trials\u003c/em\u003e. NewYork: Springer sciences; 2010, 133-169\u003c/li\u003e\n \u003cli\u003eUsang UE, Sowande OA, Adejuigbe O, Bakare TIB, Ademuyiwa OA. Day case inguinal hernia surgery in Nigeria children: prospective study. \u003cem\u003eAfr J Paediatr Surg\u003c/em\u003e. 2008; \u003cstrong\u003e52\u003c/strong\u003e: 76-78\u003c/li\u003e\n \u003cli\u003eShah JN, Pokhrel Y, Hasson K, Thapa G, Manandhar K, Maharja SB. Is routine hospital visit after day case inguinal hernia surgery in children necessary? \u003cem\u003eJ Nepal Health Res Counc\u003c/em\u003e. 2013; \u003cstrong\u003e11(23):\u003c/strong\u003e 35-39.\u003c/li\u003e\n \u003cli\u003eOmid A, Diana ND, Vahid M. New technique for herniotomy in children-Clinical trial running title: Non-ligation herniotomy in children. \u003cem\u003eAdvances in Surgical Sciences\u003c/em\u003e. 2014; \u003cstrong\u003e2(1):\u003c/strong\u003e1-4.\u003c/li\u003e\n \u003cli\u003eNatasha F, Behrouz B. Pediatric hydrocele: A comprehensive review. \u003cem\u003eCln Surg\u003c/em\u003e. 2017; \u003cstrong\u003e2\u003c/strong\u003e: 1-6\u003c/li\u003e\n \u003cli\u003eAmanollahi O, Nejad ZG, Samadzagen A. Comparison of two method of hydrocele repair in children. \u003cem\u003eIranian Journal of pediatric surgery\u003c/em\u003e. 2019; \u003cstrong\u003e5(1):\u003c/strong\u003e 33-37\u003c/li\u003e\n \u003cli\u003eParveen Z, Khan S, Sultan S, Nahar MN, Nessa G. Pattern of children presenting with inguinal hernia and hydrocele- Experience in a Tertiary level Hospital. \u003cem\u003eJAFMC Bangladesh\u003c/em\u003e. 2017; \u003cstrong\u003e13(1):\u003c/strong\u003e 46-50\u003c/li\u003e\n \u003cli\u003eErdogan D, Karaman I, Aslan MK, Karaman A, Cavusoglu YH. Analysis of 3776 pediatric inguinal hernia and hydrocele cases in a tertiary centre. \u003cem\u003eJ Ped Surg\u003c/em\u003e. 2013; \u003cstrong\u003e48\u003c/strong\u003e: 1767-1772\u003c/li\u003e\n \u003cli\u003eIbrahim M, Ladan MA, Abdussalam US, Getso KI, Mohammad MA, Chukwuemeka AL et al. Open inguinal herniotomy: Analysis of variations. \u003cem\u003eAfr J Paediatr surg\u003c/em\u003e. 2015; \u003cstrong\u003e12(2): \u003c/strong\u003e131-135\u003c/li\u003e\n \u003cli\u003eEkpemo SC. The use of prophylactic antibiotics in day case herniotomy at University of Nigeria Teaching Hospital Enugu Nigeria (dissertation). West African College of Surgeons, 2016.\u003c/li\u003e\n \u003cli\u003eVaze D, Samujh R, Narasimha Rao KL. Risk of surgical site infection in paediatric herniotomies without any prophylactic antibiotics: A preliminary experience. \u003cem\u003eAfr J Paediatr Surg\u003c/em\u003e. 2014; \u003cstrong\u003e11\u003c/strong\u003e: 158-161.\u003c/li\u003e\n \u003cli\u003eRenko M, Poalanne N, Tapiainen T, Hinkkainen M, Pokka T, Kinnula S et al. Triclosan-containing sutures versus ordinary sutures for reducing surgical site infections in children: a double blind randomized controlled trial. \u003cem\u003eLancet Infect Dis\u003c/em\u003e. 2017; \u003cstrong\u003e17(1):\u003c/strong\u003e 50-57.\u003c/li\u003e\n \u003cli\u003eSamra SS, Jagad V, Mahajan M, Randhawa MS, Trehan C. Impact of using triclosan impregnated sutures on incidence of surgical site infection: a real World Indian study. \u003cem\u003eInt Surg J\u003c/em\u003e. 2018; \u003cstrong\u003e5(2):\u003c/strong\u003e 647-652\u003c/li\u003e\n \u003cli\u003eGalal I, El-Hindawy K. Impact of using triclosan-antibacterial sutures on incidence of surgical site infection. \u003cem\u003eAm J Surg\u003c/em\u003e. 2011; \u003cstrong\u003e202(2):\u003c/strong\u003e 133-138.\u003c/li\u003e\n \u003cli\u003eAhmed I, Boulton AJ, Rizvi S, Carlos W, Dickenson E, Smith NA. The use of triclosan-coated sutures to prevent surgical site infection: a systematic review and meta-analysis of the literature. \u003cem\u003eBMJ Open\u003c/em\u003e. 2019; \u003cstrong\u003e9(9): \u003c/strong\u003e1-12\u003c/li\u003e\n \u003cli\u003eRozzelle CJ, Leonardo J, Li V. Antimicrobial suture wound closure for cerebrospinal fluid shunt surgery: a prospective double-blinded randomized controlled trial. \u003cem\u003eJ NeurosurgPediatri\u003c/em\u003e. 2008; \u003cstrong\u003e2(2):\u003c/strong\u003e 111-117\u003c/li\u003e\n \u003cli\u003eRothenburger S, Spangler D, Bhende S, Burkley D. In vitro antimicrobial evaluation of coated vicryl-plus antibacterial suture (coated polyglactin 910 with triclosan) using zone of inhibition assays. \u003cem\u003eSurg Infect\u003c/em\u003e. 2002; \u003cstrong\u003e3(suppl 1):\u003c/strong\u003e 79-87\u003c/li\u003e\n \u003cli\u003eMing X, Rothenburger S, Nichols MM. In vivo and in vitro antibacterial efficacy of PDS plus (polidioxanone with triclosan) suture. \u003cem\u003eSurg Infect\u003c/em\u003e. 2008; \u003cstrong\u003e9\u003c/strong\u003e: 451-457\u003c/li\u003e\n \u003cli\u003eAskarpour S, Peyvasteh M, Hazhir JH, Mehdianzadeh F. Recurrence and complications of paediatric inguinal hernia repair over 5years. \u003cem\u003eAnnals of pediatric surgery\u003c/em\u003e. 2013; \u003cstrong\u003e9\u003c/strong\u003e: 58-60\u003c/li\u003e\n \u003cli\u003eIbrahim M, Getso KI, Mohammad MA, Akhparov NN, Aipov RR. Herniotomy in resource-scarce environment: comparison of incisions and techniques. \u003cem\u003eAfr J Paediatr Surg\u003c/em\u003e. 2015; \u003cstrong\u003e12(1):\u003c/strong\u003e 45-50s\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the supplementary files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pediatric groin surgeries, antimicrobial (Triclosan) coated suture, prophylactic antibiotics, surgical site infections","lastPublishedDoi":"10.21203/rs.3.rs-8902559/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8902559/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSurgical site infections (SSIs) continue to occur following clean pediatric groin surgeries, despite being considered low-risk procedures. Various preventive measures have been explored to reduce this morbidity.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study aimed to compare the effectiveness of a single-dose prophylactic intravenous antibiotic regimen with triclosan-coated suture material in preventing SSI in pediatric groin surgeries.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eA prospective comparative study was conducted on pediatric patients who underwent repair of inguinal hernias or hydroceles at the University of Nigeria Teaching Hospital (UNTH), Enugu. Participants were assigned to two groups: Group A received wound closure with triclosan-coated polyglactin-910 (Vicryl-Plus), and Group B received a single preoperative intravenous dose of ampicillin/cloxacillin 30 minutes before incision. All patients were followed up for 30 days. Data were analyzed using IBM SPSS version 21.0. Categorical variables were summarized using frequencies and percentages, while continuous variables were analyzed using means and standard deviations. Chi-square tests assessed associations between categorical variables, and T-tests compared means. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 96 groin surgeries were performed on 86 patients, including 10 bilateral hernia repairs. There were 63 males (73.3%) and 23 females (26.7%). Forty-one (47.7%) had unilateral inguinal hernias, 10 (11.8%) bilateral hernias, and 35 (40.7%) hydroceles. Only one SSI (1.0%) occurred, observed in the antibiotic group (χ\u0026sup2;=1.011, p\u0026thinsp;=\u0026thinsp;0.315). Seroma occurred in 2.1% (1/48) of the Vicryl-Plus group and 4.2% (2/48) of the antibiotic group (χ\u0026sup2;=0.344, p\u0026thinsp;=\u0026thinsp;0.557). The SSI was superficial and resolved with an alternate-day dressing.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e \u003cb\u003eT\u003c/b\u003ericlosan-coated sutures and single-dose antibiotics showed similarly low SSI rates in pediatric groin surgeries. The only SSI occurred in the antibiotic group. Triclosan-coated sutures may reduce antibiotic use without compromising outcomes.\u003c/p\u003e","manuscriptTitle":"A comparative study of the effect of prophylactic intravenous antibiotics and triclosan-coated sutures in the prevention of surgical site infection in pediatric groin surgeries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 16:17:45","doi":"10.21203/rs.3.rs-8902559/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-15T17:24:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-14T07:41:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44911346683675870579241984869435877942","date":"2026-05-11T13:00:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266158189731483977294481776049328302367","date":"2026-05-08T10:03:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168873025221251396185381442658173127437","date":"2026-05-08T07:19:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-09T04:31:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T21:44:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139129636736956567097910067075357948097","date":"2026-03-30T04:52:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86578774034924550502127756998800134619","date":"2026-03-26T09:14:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19161971864569099457018028322190080766","date":"2026-03-24T08:41:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303735201905819955617586070873066533615","date":"2026-03-17T09:04:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-17T05:06:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-23T10:23:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-21T09:05:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-21T09:02:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-02-17T15:10:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e053d4b2-b781-4ac9-9a55-1ca2dd66fd80","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-15T17:24:51+00:00","index":96,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-14T07:41:26+00:00","index":95,"fulltext":""},{"type":"reviewerAgreed","content":"44911346683675870579241984869435877942","date":"2026-05-11T13:00:11+00:00","index":93,"fulltext":""},{"type":"reviewerAgreed","content":"266158189731483977294481776049328302367","date":"2026-05-08T10:03:43+00:00","index":91,"fulltext":""},{"type":"reviewerAgreed","content":"168873025221251396185381442658173127437","date":"2026-05-08T07:19:58+00:00","index":90,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T16:17:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 16:17:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8902559","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8902559","identity":"rs-8902559","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}